Angela Ki Che Leung is Director of the Hong Kong Institute for the Humanities and Social Sciences at the University of Hong Kong, and Adjunct Research Fellow with the Institute of History and Philology at the Academia Sinica in Taipei. She is the author of Leprosy in China: A History. Charlotte Furth is Professor of History Emerita at the University of Southern California. She is the author of A Flourishing Yin: Gender in China’s Medical History, 960–1665.

Charlotte Furth is Professor of History Emerita at the University of Southern California. She is the author of A Flourishing Yin: Gender in China’s Medical History, 960–1665.

Health and Hygiene in Chinese East Asia

Policies and Publics in the Long Twentieth Century

Duke University Press

Copyright © 2010 Duke University Press
All right reserved.
ISBN: 978-0-8223-4815-3

Contents

Acknowledgments…………………………………………………………………………………………………………………………………viiINTRODUCTION Hygienic Modernity in Chinese East Asia Charlotte Furth………………………………………………………………………………..1The Evolution of the Idea of Chuanran Contagion in Imperial China Angela Ki Che Leung………………………………………………………………….25The Treatment of Night Soil and Waste in Modern China Yu Xinzhong……………………………………………………………………………………51Sovereignty and the Microscope: Constituting Notifiable Infectious Disease and Containing the Manchurian Plague (1910-11) Sean Hsiang-lin Lei…………………73Eating Well in China: Diet and Hygiene in Nineteenth-Century Treaty Ports Shang-Jen Li…………………………………………………………………109Vampires in Plagueland: The Multiple Meanings of Weisheng in Manchuria Ruth Rogaski……………………………………………………………………132Have Someone Cut the Umbilical Cord: Women’s Birthing Networks, Knowledge, and Skills in Colonial Taiwan Wu Chia-Ling……………………………………..160A Forgotten War: Malaria Eradication in Taiwan, 1905-65 Lin Yi-ping and Liu Shiyung……………………………………………………………………183The Elimination of Schistosomiasis in Jiaxing and Haining Counties, 1948-58: Public Health as Political Movement Li Yushang………………………………..204Conceptual Blind Spots, Media Blindfolds: The Case of SARS and Traditional Chinese Medicine Marta E. Hanson………………………………………………228Governing Germs from Outside and Within Borders: Controlling 2003 SARS Risk in Taiwan Tseng Yen-fen and Wu Chia-Ling………………………………………255AFTERWORD Biomedicine in Chinese East Asia: From Semicolonial to Postcolonial? Warwick Anderson………………………………………………………..273Timeline……………………………………………………………………………………………………………………………………….279Glossary……………………………………………………………………………………………………………………………………….283Bibliography……………………………………………………………………………………………………………………………………287Contributors……………………………………………………………………………………………………………………………………323Index………………………………………………………………………………………………………………………………………….327

Chapter One

The Evolution of the Idea of Chuanran Contagion in Imperial China

Angela Ki Che Leung

During the last years of Qing imperial rule, when Western medicine and notions of public health were being introduced in China, intellectuals and the political elite tended to accuse Chinese society of ignorance about proper behavior related to the avoidance of diseases. Such accusations usually became particularly severe during epidemics. The ordinary Chinese were typically blamed for being superstitious, filthy, and ignorant of germs and of the danger of the spread of diseases—in other words, totally lacking basic scientific knowledge of health and hygiene.

An article from February 14, 1911, in Dagong Bao, a major newspaper published in Tianjin, compared the Chinese people, oblivious as they were to the great danger of the epidemic of pneumonic plague devastating Manchuria, to ignorant children playing around a well, unaware of their imminent danger of falling in. In his contribution to this volume, Sean Hsianglin Lei draws our attention to an important remark in the same year by Xi Liang (1853–1917), governor general of the region: “In the beginning [of the outbreak], our bureaucrats, local gentry, and medical practitioners did not believe that epidemics [yi] could spread by contagion [chuanran].”

The above two public remarks suggest that Chinese identified the plague as a manifestation of the indigenous medical category of yi or wenyi (epidemics), which was not contagious. This consensus reflected long-standing orthodox medical teachings about febrile diseases. The oldest umbrella category for these conditions was shanghan (Cold Damage). Built into shanghan doctrine were configurationist assumptions that outbreaks affecting many people at the same time were triggered by something in the environment: unseasonable weather, perhaps, or malign local qi (breath, energy). Epidemics were simply extreme variants of this pattern.

Elite writers noticed that the pneumonic plague epidemic in Manchuria—a consequence of increasing global traffic—was totally new to the Chinese. Moreover, for the Chinese authors, this newness seemed to explain popular ignorance. Nevertheless, this does not mean that the idea that some diseases could spread by contagion (chuanran) was unknown in China before 1900.

For a Chinese person before 1900, what exactly did it mean for a disease to involve chuanran? In the twentieth century, the term quickly became the standard translation for the biomedical notion of “contagion” as “the communication of disease from one person to another by bodily contact.” But chuanran was actually an old word, used as early as the tenth century to express complex and ambiguous concepts about the spread of disease from person to person. Its root ran—literally, to dye—is part of ancient compound words (i.e., words made up of two or more characters) that convey notions such as transmission, infection, or even contagion. However, it is unlikely that a Chinese in the first years of the twentieth century talking about chuanran had in mind our biomedically inflected concept of a disease transmitted from person to person via a microscopic organism. Older ideas of chuanran specific to the Chinese context may have escaped our notice because today we take this modern meaning for granted. Such attitudes reveal the particular Chinese conceptualization of the chuanran (literally, transmission by dyeing) mode of the spread of diseases before the language of Western biomedicine came to dominate Chinese public discourse later on in the twentieth century.

The purpose of this essay, therefore, is not to study the history of the concept of contagion as defined by Western biomedicine in traditional Chinese society, but to trace the evolution of the term chuanran and its changing meanings, in comparison with other terms with the root ran. By so doing, we hope to gain a better understanding of the traditional Chinese idea of the communicability of diseases, indispensable for our assessment of the reception in China of the modern Western idea of contagion.

Contagion versus Chuanran

Even in Europe, contagion as the transmission of diseases from person to person is a modern notion. It is generally agreed that there was no clear idea of contagion by contact up to the Middle Ages. Some historians believe that the Western idea of diseases’ being communicable from one person to another came from Arabic medicine in the twelfth century and was largely related to nonepidemic diseases. As late as the sixteenth century, when Girolamo Fracastoro published an important book on contagion, in which he further developed the idea of “seeds” of contagion, the mechanism and channels of contagion remained ambiguous. Ambiguities about contagion continued well into the nineteenth century. As Margaret Pelling has convincingly emphasized, the modern idea of contagion inherited a story involving “striking contrast, between the germ theorists, and the sanitarians who were miasmatists and believed that smells caused diseases … The concepts of contagion, infection and miasma accumulated layers of connotation over time, and effectively became not single concepts but many.” The contrast has been largely simplified in modern literature on the history of medical thought.

Pelling points out, for example, that it is too simplistic to say that the idea of contagion was monopolized by the scientifically minded bacteriologists and that the so-called miasmatists were anti-contagionists. In fact, the two groups had some broadly similar ideas about contagion. The transmission of poison by water or air, for instance, was accepted by both, but the miasmatists were unclear on the process by which the poison could travel from the sick to the healthy. For an influential doctor such as Max Josef von Pettenkofer, who was not a germ theorist, cholera and typhoid did not spread directly from one individual to another, but by water and air infected by germs that had become toxic in the soil after leaving the bodies of the sick. Therefore the similarities and differences between the miasmatists and bacteriologists on the question of germs and contagion were complex and subtle in the mid-nineteenth century, when Western Europe experienced its first attacks of cholera.

This observation is also shared by François Delaporte in regard to the 1832 cholera epidemic in France. In 1870, a discussion published in the British and Foreign Medico-Chirurgical Review on current theories of contagion admitted that “considerable obscurity still surrounds the whole question of the nature, origin and prevention of contagion.” Contagion is therefore a difficult concept to trace and clarify before the nineteenth century, even in Western societies. It was the gradual domination of germ theory from the late nineteenth century onward that finally shaped our modern understanding of contagion.

Chuanran, the Chinese term used by Xi Liang and other political and cultural elite writers around the beginning of the twentieth century, was equally ambiguous when used to express the spread of diseases. Between the tenth century and the end of the nineteenth, it was commonly used both as a verb and as a noun, but not as an adjective. It was used interchangeably with other terms with the root ran—such as xiangran (mutual dyeing), ranyi (exchange by dyeing), and ganran (affect by dyeing)—to express the spread of diseases during epidemics as well as the transmission of nonepidemic diseases. This illustrates the complexity and flexibility of the idea contained in the character ran. By the late imperial period, chuanran was clearly the most popular term to express the idea of the spread of diseases, including notions of contagion and infection.

Ran is a very old Chinese word, its first known meaning being to dye, implying tainting, staining, or changing color. It is interesting to note that the Eng lish word “infection” also originates from a root meaning “to put or dip into something,” “leading to inficere and infectio, staining or dyeing.” The same is true also of the nouns “contagion” and “miasma,” “which derives from the Greek verb miaino, a counterpart to the Latin inficere. Impurity is therefore a basic element in all three concepts.” Similarly, the first Chinese concepts for the spread of diseases were also derived from the idea of tainting or dyeing, implying the polluting of an originally pure object after it comes into contact with a polluting source. The process of ran could also imply an implicit transformation of the nature of the polluted object after prolonged contact with the contaminating source.

Early Connotations of Ran

As already pointed out by Barbara Volkmar, ran is the key Chinese term related to the concept of the communication of diseases. Today Chinese still use ran as a verb to describe catching a disease: ranbing literally means to become tainted with a disease. This term implies two processes—namely, a healthy person’s coming into contact with a polluting source, and the subsequent corruption of the originally healthy body. However, ran was initially not used in any medical context. It should therefore be useful if we first trace the use of the word in ancient Chinese, for a better appreciation of the original use of ran as an expression of contamination.

Dyeing was an important undertaking in ancient China, especially the dyeing of raw white silk into different colors, a task that was entrusted only to specialists in the Western Zhou court (roughly the eleventh to eighth centuries BCE). Later on, ran, always in the form of a verb, was used metaphorically, meaning to contaminate, especially in the context of bad customs and mores. The Shang shu (meaning “book of history,” compiled around the fourth century BCE) already used ran to mean the corrupting of customs by external influence. Such a usage was fairly common in ancient texts, mostly in the negative sense, but sometimes in the neutral or even positive sense, meaning customs were or could be ran (changed or improved) by external influences. This usage of ran became very common in ancient classics and historical writings, often in combination with jian (to immerse): jianran literally means to take up new color after prolonged immersion. According to the philosopher Mozi, this process caused a “change in the nature” of a person.

One of the first appearances of ran in the sense of disease spreading appears in the San guo zhi (History of the three kingdoms) from the third century Ce. In the extreme south of China, where “water and earth” were saturated with “poisonous qi,” soldiers and ordinary people traveling in and out of the region would “certainly develop illnesses and contaminate each other” (zhuan xiang wu ran). The spread of disease is here linked to the concept of ubiquitous poisonous air and the large number of people exposed to such environmental influences. A similar term also appears in the Zhouhou beiji fang (Handy recipes for urgent uses), a famous contemporaneous medical text by Ge Hong (283-343). In this text, a dozen recipes, many of which are more ritual than herbal, are said to be effective in stopping wenbing (Warm Disease—that is, illnesses that are caught in the cold season but that develop only during the warm season), so that patients with such conditions would not xiangran zhuo (contaminate and affect each other). Judging from the fact that these recipes treated not only the patients themselves, but also members of the household and even the residence, we might conjecture that the idea of the spread of disease was linked essentially with contaminated bad air within the area of the household. The word zhuo is of particular interest here, as it emphasizes the effect of “being affected,” implying some fundamental change in the healthy body after the tainting process. Zhuo would later on be used rather frequently with ran (ranzhuo) to express a serious case of disease-causing contamination.

It is important to emphasize that phrases containing ran to convey the spread of disease did not appear in the earliest medical classics. Indeed, those works were mostly concerned with the cosmic relations between the individual body and the environment. Discussions on the body as a vehicle for disease transmission appear in the literature only after the third century CE.

In the following paragraphs, I attempt to show that there is a historical development of the terms incorporating ran toward more specific modes of disease transmission after their first appearance. I would, first of all, suggest the following chronology: The idea of the spread of disease by contamination emerged around the third century CE, evidenced by the fact that the first terms containing ran in this sense are found in this period. The idea began as a vague and complex notion. Its content became richer by the seventh century, when the major modes of disease transmission were described and more or less fixed. From the tenth century on, and particularly after the twelfth century, with the emergence and popularization of the term chuanran, contamination by personal contact with the sick gained increasing attention. This concept of transmission was developed fully and in more concrete terms in the late imperial period. I would like to begin this discussion with Chao Yuanfang’s classic, Zhubing yuan hou lun (On the origins and symptoms of all diseases), an important text compiled in 610 CE, in which the basic modes of disease transmission were described in detail.

Modes of Disease Transmission from the Seventh to the Twelfth Centuries

Chao Yuanfang’s classic provides the fullest account of the main modes of disease transmission within the specific social and religious context of the early seventh century. We can distinguish three major modes of transmission that were expressed by terms containing ran and also yi (exchange) in this important text.

Transmission by Contamination and Switching (Answering Question 1015)

First, we find jianran (dye by immersion; also in the reverse order as ranjian). This term already occurs in ancient nonmedical texts to express the notion that prolonged contact with a polluting source provoked a change in the nature of a person. By contrast, Chao used the term to describe contamination within the body. Several disorders were characterized by the gradual growth of diseased parts inside the body that finally affected surrounding healthy parts, leading to more serious and distinct pathological conditions. The disorder called zheng, for instance, was initially caused by depletion of the viscera and bowels, leading to indigestion. The internal congestion “after prolonged and deep imbuing” later on coagulated into a solid and immovable block, finally turning into a zheng (concretion). Another example is excessive skin or a polyp growing on the eye, which was explained as the result of “prolonged tainting and immersion” of the corner of the eye with hot qi rising from the Liver. The symptom of “great heat” (zhuangre) in children was explained by conflicting cold and hot qi inside the intestines and stomach that “emerge after prolonged tainting and immersion.”

One can conjecture from these cases that jianran in such disorders referred to contamination of the healthy parts of the body by an originally smaller, sick part that had developed a pathology, after a period of “immersion.” In a way, jianran is comparable to what we now understand as infection—that is, a kind of internal contamination causing a fundamental deterioration of the concerned body part, showing symptoms different from the original malaise. The original disorder thus underwent a radical transformation after prolonged imbuing and became something quite different and more serious for the patient.

The second mode of ran as disease transmission discussed in Chao’s text is expressed by the term xiangran (mutual contamination) or its variations, such as zhuan xiangran yi and xiangran yi. Xiangran was perhaps the most frequently used term for contamination in the medieval period—meaning, mostly, contamination by sickly qi that existed in a specific locality or was generated by patients. Most of the time, the term referred to tainting by bad, pathogenic qi in the atmosphere. Chao specifically saw unseasonable (shi) or perverse (guaili) qi as causing illnesses that would “contaminate and exchange [hosts]” (xiangran yi). Warm Diseases (wenbing) would also emit a pathogenic qi (bingqi) that would shift, contaminate, and exchange hosts, in a two-stage process: annihilating first the entire family (miemen), and then outsiders. Unlike the shanghan (Cold Damage) disorders caused by cold and discussed by Zhang Ji during the Han dynasty, warm diseases and disorders caused by unseasonable qi would “affect by dyeing/contaminating” (ranzhuo) and were thus more dangerous. Similar observations were also made by other major doctors of the period, such as Sun Simiao. The key polluting element involved in the xiangran mode of transmission was the pathogenic qi that affected people under its influence. The presence of such qi was a necessary condition for the secondary person-to-person transmission that affected first family members and then outsiders.

(Continues…)

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